WVPTA PT After Hours
At the end of this session, participants will be
able to:
 Identify the electronic resources available to
practicing clinicians to improve access to
evidence regarding PT practice.
 Report the function of APTA’s Open Door
Portal
 Identify the location and purpose of the APTA
Legislative Action Center
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Identify the benefits to patient care from
using current evidence in practice.
Define tele-rehabiliation
Identify the equipment necessary to create a
tele-rehabilitation site within a clinical
setting.
List the benefits of tele-rehabilitation to the
consumers of health care in WV, specifically in
rural areas.
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Efficiency in practice logistics
 Scheduling
 Billing
 Documentation
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Providing resources for clinical decision
making
Patient educational tools
Assuring regulatory compliance
Productivity/budgetary/outcomes reporting
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iOrtho
OMT – spine and extremities
iMuscle
WebMD
Medscape
Radiology
Pharmacology
Skyscape
ICD9/10 codes
And the list goes on and on and on………
Practice Management Software
 APTA Connect
 Rehab Optima
 Physical Therapy Advantage
 Clinic Source
 ReDoc
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Evidence
 I don’t know where to get to it.
 I don’t have time for look for it.
 I don’t know how to ask for it.
 I don’t know how to evaluate it.
 I don’t know what it means to my patient.
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APTA1
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Internet
 Open Door
 Too many to list!
 Hooked on Evidence
 Facebook
 PTJ and section journals
 Twitter
 PT Now
 PT Think Tank
 Move Forward
▪ http://ptthinktank.com
 Physiopedia
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Open Door - http://www.apta.org/OpenDoor
 Portal that provides access to multiple databases
and full text articles to APTA members.
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ProQuest
Medline
CINAHL
Cochrane
SportDiscus
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Hooked on Evidence http://www.hookedonevidence.org/reviewstatio
n.cfm?CFID=90895431&CFTOKEN=43781805
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Journal of Physical Therapy http://ptjournal.apta.org/
 full text articles
 Podcasts
 Videos
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PT Now – Clinician portal –
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http://www.apta.org/PTNow
Robust Google-type search
Clinical summaries
Examination tools and multimedia resources
Quick route to clinical practice guidelines, best practice
recommendations, outcomes data, systematic reviews, and
policy statements
News for clinical practice
Drug updates
Discussion forums targeted to clinical topics
Customizable clinical collections for sharing with patients and
colleagues
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Move Forward – Consumer Portal
 http://www.moveforwardpt.com/Default.aspx
 Consumer portal with information regarding
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diagnoses, physical therapy intervention
Consumer videos
Interactive body
Symptoms and conditions
Find a PT
Todays PT
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APTA Legislative Action Center
 Federal Advocacy
 State Advocacy
 Take Action
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Health Care Reform
 Provides summary of PPACA related to PT
profession
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Legislative Issues
 http://www.apta.org/FederalIssues
 What APTA is addressing on Capitol Hill regarding
PT practice nationwide
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News and Updates – PTeam newsletter
Policy Resources
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Justin Elliott – Director
Angela Chasteen – Assistant Director
 Current issues
 State legislative issue tracking
 Grants for advocacy work
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So why do I need to know this? And, what do
I do with this information?
 http://app3.vocusgr.com/WebPublish/controller.as
px?SiteName=APTA&Definition=Home&XSL=Ho
me&SV_Section=Home
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USDHHR definition:
 Use of electronic information and
telecommunications technologies to support
long-distance clinical healthcare, patient and
professional health-related education, public
health and health administration.
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Telemedicine 2
 Use of technologies to assist in delivering
healthcare services such as patient care and
monitoring.
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Telerehabilitation2
 Remote delivery of rehabilitation and home care
services.
▪ Assessment, monitoring, prevention, intervention,
supervision, education, consultation, counseling
▪ PT, OT, SLP, audiologists, physiatrists, nurses,
bioengineers, AT experts, teachers, psychologists,
dieticians.
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History2
 1880s – after the invention of the telephone
 US Government
▪ VA utilization 1957 – telemental health with other
projects to follow
▪ Now it is system wide throughout the VA
▪ Recent past – most research activity in telehealth
surrounds rural medicine
 1997 telehealth business – 6.8 million
 1998 telehealth business – 13.8 million
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Benefits3
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Increases access to care/ speed of diagnosis
Increased quality of care
Increased access to specialized services
Cost- effective
Decreased travel time for patient/practitioner
More time for practitioner to see more patients with less
travel time
 Patient and practitioner satisfaction
 Comparable outcomes to face to face
 Practitioner education/mentorship
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Lets talk dollars and ‘sense’!
 Very little quality economic analyses of this
method of delivery
 Cusack4 study results
▪ Factors affecting results – cost of face to face visit vs
cost of telehealth visit, success of telehealth visit
 Vo5 study results – UTMD
 Univ. of TN – Telehealth Network
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Pramuka6
 Text based
 Audio based
 Video based
 Virtual reality
 Web based
 Wireless
 Integrated
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What equipment might I need?
 Don’t ask me!!!!! But, seriously folks….
▪ Conferencing telephone
▪ Internet access – broadband – high speed
▪ Smart phone
▪ Videoconferencing equipment
▪ Monitoring equipment
 Check out the Mountaineers
▪ http://www.hsc.wvu.edu/its/MDTV
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So, what’s right for me?
 Consider:
▪ Data type to be transmitted
▪ Clinic’s budget
▪ Application purpose/patient characteristics
▪ Technical support structure
▪ Skills of client and clinician – both tech and rehab skill
▪ Ease of installation
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Barriers
 Lack of professional competency standards
 Degree of physical contact
 Patient cognition
 Availability of resources for interventions
 Reimbursement models do not support TR
 Liability clarifications
 Quality of tech devices
 Licensure clarification
 HIPPA
 Lack of literature to base policy change on
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Policy issues to be addressed2
 Licensure
 Consistent clinical standards
 Privacy and access to PHI
 Reimbursement standards across state lines
 Reimbursement period! For telehealth services
 Liability and accountability
 International rules on clinical consultations
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Purpose
Subjects
 Telerehab – 10
 Out of region face to face – 10
 In region face to face – 10
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Results
 Consistent satisfaction and goal achievement
among groups
 Telerehab group assessed sooner
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Purpose
Subjects
 11 caregivers of elderly clients diagnosed with
Parkinson’s Disease
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Results
 Time saved
 Work time saved
 Cost savings
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Increased access to services regardless of
geography
 Vocational assessment
 Employment preparation
 Seeking and obtaining employment
 Maintaining employment (job coaching)
 Monitoring and follow up
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Purpose
Subjects
 5 subjects (3 men and 2 women)
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Results
 Clinical outcomes improved
 Levels of satisfaction were high for both
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Type in rehabilitation and what do you get?
 88,200 results
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Type in physical therapy and what do you
get?
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67,900 results
Posted by?
Accuracy?
Appropriateness?
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So, what do I do with it?
 As of 2009, 68% of American households had
computers with internet access
 Create Private Channels - Post videos specifically
for your patients as homework to supplement
your care
 Parental controls to limit access
 Use audio via telephone during simultaneous
viewing of the video
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“…telerehabilitation is a feasible service
delivery model that has the potential to
improve access and reduce the costs
associated with delivery of early intervention
services in rural communities”.11
“…telehealth services are not meant to
replace face-to-face services, but when inperson services are not feasible, they provide
a viable alternative”.11
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Kentucky Telehealth Network
 100 telehealth sites
▪ MDTV has 35 in the state, 1 in MD and 7 international
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Purpose
 TR as alternative deliver model for EI services in
KY
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Subjects
 2 families in rural KY receiving OT x 12 weeks
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Results
1. American Physical Therapy Association. www.apta.org
2. Seelman KD, Hartman LM. Telerehabilitation: policy issues
and research tools. Intl J Telerehab. 2008;37-48.
3. Schmeler MR, Schein RM, McCue M, Betz K.
Telerehabilitation clinical and vocational applications for
assistive technology: research, opportunities and
challenges. Intl J Telerehab. 2008(fall):12-24.
4. Cusack CM, et al. The value proposition in the widespread
use of telehealth. J Telemed Telecare. 2008;14(4):167-68.
5. Vo AH. The telehealth promise: better health care and cost
savings for the 21st centruy. Retrived October 18, 2011 from
http://ehealthvirginia.org/downloads/20080529/UTMB%20
Telemedicine%20White%20Paper%2019May2008.pdf.
6. Pramuka M, van Roosmalen L. Telerehabilitation
technologies: accessibility and usability. Intl J Telerehab.
2008;1(1): 25-36.
7. Barlow IG, Liu L, Sekulic A. Wheelchair seating assessment and
intervnetion: a comparison between telerehabilitation and face to face
service. Intl J Telerehab. 2009;1(1):17-27.
8. Tindall LR, Huebner RA. The impact of an application of
telerehabilitation technology on caregiver burder. Intl J Telerehab.
2009;1(1): 3-7.
9. Tousignant M, Boissy P, Corriveau H, Moffet H, Cabana F. In-home
telerehabilitation for post-knee arthroplasty: a pilot study. Intl J
Telerehab. 2009;1(1):9-16.
10.Manasco HM, Barone N, Brown A. A role for YouTube in
telerehabilitation. Intl J Telerehab. 2010;2(2): 15-18.
11.Cason J. Telerehabilitation: an adjunct service delivery model for early
intervention services. Intl J Telerehab. 2011;3(1): 19-29.
12.Cason J. A pilot telerehabilitation program: delivering early intervention
services to rural families. Intl J Telerehab. 2009;1(1): 29-37.
13. American Telemedicine Association